Qualis Health – the
Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Idaho
and Washington – is working to improve quality reporting for clinicians,
including those at physician practices and at larger health care facilities.

Critical Access Hospitals in
Idaho

In December 2015, the Idaho
Bureau of Rural Health conducted a collaborative needs assessment among
Critical Access Hospitals (CAHs) that provided insight into their past
reporting experiences, challenges and educational needs related to the
Physician Quality Reporting System (PQRS), a precursor to the Medicare Access
and CHIP Reauthorization Act (MACRA).

“CAHs are community hospitals that
have close relationships with their local clinical providers,” says Qualis
Health Idaho State Director Linda Rowe. “They have limited resources, so we
approached our network of CAHs differently than other hospitals and focused on
their unique areas of importance.”

Qualis Health used the information
from the Bureau of Rural Health to develop a comprehensive education plan for
10 CAHs that has resulted in approximately 700 providers avoiding nearly
$275,000 in penalties and a 43 percent relative improvement in participation of
reporting 2016 PQRS data.

As part of its strategy, the QIN-QIO developed educational materials,
held community lunch-and-learns at local hospitals across the state, and hosted
webinars on aligning physician efforts between PQRS and other clinical goals
like Medicare Beneficiary Quality
Improvement Project measures and other incentive programs.

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“It takes a team to make quality reporting happen.”

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Qualis Health also developed the MIPS
Minute, a 12-part video
podcast series with more than 2,200 views as of December 2016, to help facilities and
physicians understand the basics as the Quality Payment Program launches
in 2017.

“Understanding
the complexities of MACRA will be essential for physicians and practice staff
that care for Medicare patients. The MIPS Minutes videos are an excellent
vehicle for building that knowledge base,” a representative of the Washington
State Medical Association says.

The QIN-QIO plans to release an
updated MIPS Minute series on the final MACRA rules in early 2017.

Idaho is a primarily rural state,
which in-and-of-itself can provide unique challenges. The QIN-QIO used a small
team approach and leveraged the role of hospitals and providers, many of which
are on their own, to foster team support in rural communities. “It takes a team
to make quality reporting happen,” says Qualis Health’s Idaho Quality
Improvement Consultant Deanna Graham.

“As conveners and collaborators,
we are thankful that the relationships we have developed in Idaho are moving
the needle on quality improvement. We’ve seen many more organizations and
providers who now have experience in quality reporting that will be the
foundation for their success with the new Quality Payment Program under MACRA,”
Graham concludes.

Ambulatory
Surgery Centers in Washington

In
Washington in 2016, Qualis Health concentrated on ambulatory surgery centers
(ASCs), which account for more than 60 percent of all surgical procedures
performed in the United States. The QIN-QIO focused on infection prevention – a
topic of great interest to ASCs – to engage them in how to use their data for
quality improvement purposes and prepare them for pay-for-performance.

Unlike
in hospitals, rates of surgical site infections (SSIs) in ASCs are not well
known for a variety of reasons, including lack of standard infection
definitions for most procedures performed, limited reporting of infections, and
inconsistent coding for health care-associated infections in claims data.

However,
preliminary analysis of ASC Medicare claims data for Washington shows a rate of
2.85 post-operative infections per 1,000 procedures, which, while low compared
to hospital rates, represents a substantial number of adverse outcomes in
aggregate, given the high volume of procedures performed in these settings.

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"We...focused on building communication between various levels of staff with checklists, culture change tools and anything that improves teamwork."

To
engage ASCs and support them in the transition from pay-for-reporting to
pay-for-performance, Qualis Health provided half-day infection prevention
trainings for approximately 40 ASCs, as well as on-site walkthroughs where
possible. The four- to five-hour workshops were interactive and included
detailed technical advice relating to care of environment, sequencing of
processes, risk assessments and high-level disinfection and cleaning. They also
received intensive training on how to use data for quality improvement.

“It’s
important for facilities to have scientific tools to gather data they can
demonstrate to surveyors and other stakeholders,” says Qualis Health Quality
Improvement Consultant Jeff West. “Our focus was on engaging these
types of providers on motivating infection control and accurate reporting.”

One day
when the clinic was closed to surgery, Qualis Health provided an on-site
walkthrough where the entire nursing, technical and administrative staff
followed the typical path of patient flow, starting with the waiting room and
moving through pre-op, operating room and post-op care.

“ASCs are known for being
physician-owned and run with hierarchical structure, thus, we also focused on
building communication between various levels of staff with checklists, culture
change tools and anything that improves teamwork,” West said.

In 2017, Qualis Health plans to
focus on expanding SSI control training with a long series of webinars that
repurpose materials and include expert guest speakers as well as QIN-QIO staff.